Skip to main content Accessibility help

How Do Parents Influence Child Disruptive Behavior After Acquired Brain Injury? Evidence From a Mediation Model and Path Analysis

  • Clara Chavez-Arana (a1) (a2) (a3), Cathy Catroppa (a1) (a2) (a4), Guillermina Yáñez-Téllez (a3), Belén Prieto-Corona (a3), Adriana Amaya-Hernández (a3), Miguel A. de León (a5), Antonio García (a6), Roberto Gómez-Raygoza (a7), Stephen J. C. Hearps (a1) and Vicki Anderson (a1) (a2) (a4)...


Objectives: Children with acquired brain injury (ABI) can present with disruptive behavior, which is often a consequence of injury and parent factors. Parent factors are associated with child disruptive behavior. Furthermore, disinhibition in the child also leads to disruptive behavior. However, it is unclear how these factors interact. We investigated whether parental factors influence child disruptive behavior following ABI and how these factors interact. Methods: Parents of 77 children with ABI participated in the study. Parent factors (executive dysfunction, trait-anxiety), potential intervention targets (dysfunctional parenting practices, parental stress, child disinhibition), and child disruptive behavior were assessed. A hypothetical model based on the literature was tested using mediation and path analysis. Results: Mediation analysis revealed that child disinhibition and dysfunctional parenting practices mediated the association of parent factors and child disruptive behavior. Parents’ executive dysfunction mediated the association of dysfunctional parenting practices, parental stress and parent trait-anxiety. Parenting practices mediated the association of executive dysfunction and child disruptive behavior. Path analysis indices indicated good model adjustment. Comparative and Tucker-Lewis Index were >0.95, and the root mean square error of approximation was 0.059, with a chi-square of 0.25. Conclusions: A low level of parental trait-anxiety may be required to reduce dysfunctional parenting practices and child disinhibition. Impairments in child disinhibition can be exacerbated when parents present with high trait-anxiety. Child disinhibition is the major contributor of disruptive behavior reported by parents and teachers. The current study provides evidence of parent anxiety and child disinhibition as possible modifiable intervention targets for reducing child disruptive behavior. (JINS, 2019, 25, 237–248)


Corresponding author

Correspondence and reprint requests to: Clara Chavez-Arana, E-mail:


Hide All
Abidin, R. (2012). Parent stress index (4th ed.). Lutz, FL: PAR.
Aktar, E., Nikolic, M., & Bögels, S. (2017). Environmental transmission of generalized anxiety disorder from parents to children: Worries, experiential avoidance, and intolerance of uncertainty. Dialogues in Clinical Research, 19(2), 137147.
Amato, P., & Fowler, F. (2002). Parenting practices, child adjustment, and family diversity. Journal of Marriage and Family, 64(3), 703716.
Amaya-Hernández, A., Mancilla-Diaz, J. M., Alvarez-Rayon, G., Ortega-Luyando, M., Larios- Lopez, M., & Martinez-Guerrero, J. (2013). Awareness and Internalization of body ideal as predictors of body dissatisfaction and disordered eating behaviors. Revista Colombiana de Psicologia, 22(1), 121133.
Anastopoulos, A. D., Guevremont, D. C., Shelton, T., & DuPaul, G. J. (1992). Parenting stress among families of children with attention deficit and hyperactivity disorder. Journal of Abnormal Child Psychology, 20(5), 503520.
Anderson, V., Catroppa, C., Haritou, F., Morse, S., & Rosenfeld, J. (2005). Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children. Journal of Neurology, Neurosurgery, & Psychiatry, 76(3), 401408. doi:10.1136/jnnp.2003.01917
Anderson, V., Jacobs, R., & Anderson, P. J. (2008). Executive functions and the frontal lobes: A lifespan perspective. New York: Taylor & Francis.
Anderson, V., Godfrey, C., Rosenfeld, J. V., & Catroppa, C. (2012). Predictors of cognitive function and recovery 10 years after traumatic brain injury in young children. Pediatrics, 129(2), e254261. doi:10.1542/peds.2011-0311
Arnold, D., O’Leary, S., Wolff, L., & Acker, M. (1993). The Parenting scale: A measure of dysfunctional parenting in discipline situations. Psychological Assessment, 5(2), 137144.
Barkley, R. A. (2001). The executive functions and self-regulation: An evolutionary neuropsychological perspective. Neuropsychology Review, 11(1), 127.
Barrett, J., & Fleming, A. S. (2011). Annual research review: All mothers are not created equal: Neural and psychobiological perspectives on mothering and the importance of individual differences. Journal of Child Psychology and Psychiatry, 52(4), 368397. doi:10.1111/j.1469-7610.2010.02306.x
Brown, F. L., Whittingham, K., Boyd, R. N., McKinlay, L., & Sofronoff, K. (2014). Improving child and parenting outcomes following paediatric acquired brain injury: A randomised controlled trial of stepping stones triple P plus acceptance and commitment therapy. Journal of Child Psychology and Psychiatry, 55(10), 11721183. doi:10.1111/jcpp.12227
Bernier, A., Carlson, S. M., & Whipple, N. (2010). From external regulation to self-regulation: Early parenting precursors of young children’s executive functioning. Child Development, 81(1), 326339.
Braumind, D. (1971). Current patterns of parental authority. Developmental Psychology Monographs of the Society for Research in Child Development, 4(1), 1103.
Bridgett, D. J., Burt, N. M., Edwards, E. S., & Deater-Deckard, K. (2015). Intergenerational transmission of self-regulation: A multidisciplinary review and integrative conceptual framework. Psychology Bulletin, 141(3), 602654. doi:10.1037/a0038662
Bridgett, D. J., Gartstein, M. A., Putnam, S. P., Lance, K. O., Iddins, E., Waits, R., . . . Lee, L. (2011). Emerging effortful control in toddlerhood: The role of infant orienting/regulation, maternal effortful control, and maternal time spent in caregiving activities. Infant Behavior and Development, 34(1), 189199. doi:10.1016/j.infbeh.2010.12.008
Bridgett, D. J., Kanya, M. J., Rutherford, H. J., & Mayes, L. C. (2017). Maternal executive functioning as a mechanism in the intergenerational transmission of parenting: Preliminary evidence. Journal of Family Psychology, 31(1), 1929. doi:10.1037/fam0000264
Chavez, C. L., Yanez, G., Catroppa, C., Rojas, S., Escartin, E., Hearps, S. J., & Garcia, A. (2015). Adolescents with vascular frontal lesion: A neuropsychological follow-up case study. Neurocirugia (Asturias), 27(3), 136143. doi:10.1016/j.neucir.2015.09.001
Chavez-Arana, C., Catroppa, C., Yáñez Téllez, G., Godfrey, C., Prieto-Corona, B., De León, M., … Anderson, V. (2017). Feasibility and effectiveness of a parenting program for Mexican parents of children with acquired brain injury: Case report. Brain Injury, 32(2), 276285. doi:10.1080/02699052.2017.1394491
Chavez-Arana, C., Catroppa, C., Carranza-Escárcega, E., Godfrey, C., Yáñez-Téllez, G., Prieto-Corona, B., … Anderson, V. (2018). A Systematic review of Interventions for hot and cold executive functions in children and adolescents with acquired brain injury. Journal of Pediatric Psychology, 43(8), 928942. doi:10.1093/jpepsy/jsy013
Chavez-Arana, C., Catroppa, C., Hearps, S. J. C., Yáñez Téllez, G., Prieto-Corona, B., de León, M. A., García, A., Gómez-Raygoza, R., & Anderson, V. Program for Mexican parents of children with acquired brain injury. Results from a randomised controlled trial. Manuscript submitted.
Crandall, A., Deater-Deckard, K., & Riley, A. W. (2015). Maternal emotion and cognitive control capacities and parenting: A conceptual framework. Developmental Review, 36, 105126. doi:10.1016/j.dr.2015.01.004
Crowe, L. M., Catroppa, C., Babl, F. E., Rosenfeld, J. V., & Anderson, V. (2012). Timing of traumatic brain injury in childhood and intellectual outcome. Journal of Pediatric Psychology, 37(7), 745754. doi:10.1093/jpepsy/jss070
Cuevas, K., Deater-Deckard, K., Kim-Spoon, J., Watson, A. J., Morasch, K. C., & Bell, M. A. (2014). What’s mom got to do with it? Contributions of maternal executive function and caregiving to the development of executive function across early childhood. Developmental Science, 17(2), 224238. doi:10.1111/desc.12073
Díaz-Guerrero, R., & Spielberger, C. (1975). IDARE: Inventario de ansiedad: Rasgo-Estado. México: Manual Moderno.
Durish, C. L., Yeates, K. O., Stancin, T., Taylor, H. G., Walz, N. C., & Wade, S. L. (2018). Home Environment as a predictor of long-term executive functioning following early childhood traumatic brain injury. Journal of the International Neuropsychological Society, 24(1), 1121. doi:10.1017/S1355617717000595
Eyberg, S., & Pincus, D. (1999). Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory-revised. Florida: PAR.
Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336353. doi:10.1037/1528-3542.7.2.336
Fairchild, A. J., & McDaniel, H. L. (2017). Best (but oft-forgotten) practices: Mediation analysis. The American Journal of Clinical Nutrition, 105(6), 12591271. doi:10.3945/ajcn.117.152546
Feeney, T. (2010). There’s always something that works: Principles and practices of positive support for individuals with traumatic brain injury and problem behaviors. Seminars in Speech and Language, 31(3), 145161. doi:10.1055/s-0030-1257531
Fales, J. L., Essner, B. S., Harris, M. A., & Palermo, T. M. (2014). When helping hurts: Miscarried helping in families of youth with chronic pain. Journal of Pediatric Psychology, 39(4), 427437. doi:10.1093/jpepsy/jsu003
Finch, J., & West, S. (1997). The investigation of personality structure: Statistical models. Journal of Research in Personality, 31, 439485.
Ganesalingam, K., Sanson, A., Anderson, V., & Yeates, K. O. (2007). Self-regulation as a mediator of the effects of childhood traumatic brain injury on social and behavioral functioning. Journal of the International Neuropsychological Society, 13, 298311.
Gioia, G. A., lsquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior Rating Inventory of Executive Function Professional manual. Florida: PAR.
Greenham, M., Hearps, S. J., Gomes, A., Rinehart, N., Gonzalez, L., Gordon, A., … Anderson, V. (2015). Environmental contributions to social and mental health outcomes following pediatric stroke. Developmental Neuropsychology, 40(6), 348362. doi:10.1080/87565641.2015.1095191
Gu, R., Huang, Y. X., & Luo, Y. J. (2010). Anxiety and feedback negativity. Psychophysiology, 47(5), 961967. doi:10.1111/j.1469-8986.2010.00997.
Hawley, C. A., Ward, A. B., Magnay, A. R., & Long, J. (2009). Parental stress and burden following traumatic brain injury amongst children and adolescents. Brain Injury, 17(1), 123. doi:10.1080/0269905021000010096
Henrichs, J., Schenk, J. J., Kok, R., Ftitache, B., Schmidt, H. G., Hofman, A., … Tiemeier, H. (2011). Parental family stress during pregnancy and cognitive functioning in early childhood: The generation R study. Early Childhood Research Quarterly, 26(3), 332343. doi:10.1016/j.ecresq.2011.01.003
Hoehn, J., Foxen-Craft, E., Pinder, W., & Dahlquist, L. M. (2016). The role of parents in promoting children’s adjustment to chronic illness. In C. De Michelis & M. Ferrari (Eds.), Child and adolescent resilience within medical contexts: Integrating research and practice (pp. 105119). Switzerland: Springer International Publishing.
Iacobucci, D. (Ed.) (2008). Mediation analysis. Thousand Oaks, CA: SAGE Publications, Inc. Retrieved from doi:10.4135/9781412984966
Jacobs, R., Harvey, A. S., & Anderson, V. (2011). Are executive skills primarily mediated by the prefrontal cortex in childhood? Examination of focal brain lesions in childhood. Cortex, 47(7), 808824. doi:10.1016/j.cortex.2010.06.002
Jordan, J., & Linden, M. A. (2013). ‘It’s like a problem that doesn’t exist’: The emotional well-being of mothers caring for a child with brain injury. Brain Injury, 27(9), 10631072. doi:10.3109/02699052.2013.794962
Kok, R., Lucassen, N., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Ghassabian, A., Roza, S. J., … Tiemeier, H. (2014). Parenting, corpus callosum, and executive function in preschool children. Child Neuropsychology, 20(5), 583606. doi:10.1080/09297049.2013.832741
Laugeson, E. A., & Park, M. N. (2014). Using a CBT approach to teach social skills to adolescents with autism spectrum disorder and other social challenges: The PEERS® method. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 32(1), 8497. doi:10.1007/s10942-014-0181-8
Lewis-Morrarty, E., Degnan, K. A., Chronis-Tuscano, A., Pine, D. S., Henderson, H. A., & Fox, N. A. (2015). Infant attachment security and early childhood behavioral inhibition interact to predict adolescent social anxiety symptoms. Child Development, 86(2), 598613. doi:10.1111/cdev.12336
Lønfeldt, N. N., Marin, C. E., Silverman, W. K., Reinholdt-Dunne, M. L., & Esbjørn, B. H. (2017). The role of metacognitions in the association between children’s perceptions of maternal control and anxiety. Journal of Child and Family Studies, 26(5), 13981408. doi:10.1007/s10826-017-0664-1
Lucassen, N., Kok, R., Bakermans-Kranenburg, M. J., Van Ijzendoorn, M. H., Jaddoe, V. W., Hofman, A., … Tiemeier, H. (2015). Executive functions in early childhood: The role of maternal and paternal parenting practices. British Journal of Developmental Psychology, 33(4), 489505. doi:10.1111/bjdp.12112
Max, J., Koele, S. L., Smith, W. L., Sato, Y., Lindgren, S. D., Robin, D. A., & Arndt, S. (1998). Psychiatric disorders in children and adolescents after severe traumatic brain injury: A controlled study. Psychiatric Sequelae of Severe TBI, 37(8), 833840.
McKinlay, A., Linder, M., DePompei, R., Aaro Jonsson, C., Anderson, V., Braga, L., … Wicks, B. (2016) Service provision for children and young people with acquire brain injury: Practice recommendations. Brain Injury, 30(13-14), 16561664. doi:10.1080/02699052.2016.1201592
Micklewright, J. L., King, T. Z., O’Toole, K., Henrich, C., & Floyd, F. J. (2012). Parental distress, parenting practices, and child adaptive outcomes following traumatic brain injury. Journal of International Neuropsychology Society, 18(2), 343350. doi:10.1017/S1355617711001792
Morris, A. S., Silk, J. S., Steinberg, L., Myers, S. S., & Robinson, L. R. (2007). The role of the family context in the development of emotion regulation. Social Development, 16(2), 361388. doi:10.1111/j.1467-9507.2007.00389.x
Murray, A. L., Scratch, S. E., Thompson, D. K., Inder, T. E., Doyle, L. W., Anderson, J. F., & Anderson, P. J. (2014). Neonatal brain pathology predicts adverse attention and processing speed outcomes in very preterm and/or very low birth weight children. Neuropsychology, 28(4), 552562. doi:10.1037/neu0000071
Munoz, L. C., & Anastassiou-Hadjicharalambous, X. (2011). Disinhibited behaviors in young children: Relations with impulsivity and autonomic psychophysiology. Biological Psychology, 86(3), 349359. doi:10.1016/j.biopsycho.2011.01.007
Muscara, F., Burke, K., McCarthy, M. C., Anderson, V. A., Hearps, S. J., Hearps, S. J., … Nicholson, J. M. (2015). Parent distress reactions following a serious illness or injury in their child: A protocol paper for the take a breath cohort study. BMC Psychiatry, 15, 153. doi:10.1186/s12888-015-0519-5
Nachmias, M., Gunnar, M., Mangelsdorf, S., Parritz, R. H., & Buss, K. (1996). Behavioral inhibition and stress reactivity: Moderating role of attachment security. Child Development, 67, 508522.
O’Neil, B., Jamieson, M., & Goodwin, R. (2017) Using technology to overcome impairments of mental functions. In B. A. Wilson, J. Winegardber, C. van Heugten, & T. Ownsworth (Eds.), Neuropsychological rehabilitation. London and New York: Routledge.
Peyrot, M. (1996). Causal analysis: Theory and application. Journal of Pediatric Psychology, 21(1), 324.
Pluess, M., Bolten, M., Pirke, K. M., & Hellhammer, D. (2010). Maternal trait anxiety, emotional distress, and salivary cortisol in pregnancy. Biological Psychology, 83(3), 169175. doi:10.1016/j.biopsycho.2009.12.005
Power, T., Dahlquist, L. M., Thompson, S. M., & Warren, R. (2003). Interactions between children with juvenile rheumatoid arthritis and their mothers. Journal of Pediatric Psychology, 28(3), 213221.
Prigatano, G. P., & Gray, J. A. (2007). Parental concerns and distress after paediatric traumatic brain injury: A qualitative study. Brain Injury, 21(7), 721729. doi:10.1080/02699050701481605
Prinzie, P., Onghena, P., Hellinckx, W., Grietens, H., Ghesquière, P., & Colpin, H. (2003). The additive and interactive effects of parenting and children’s personality on externalizing behaviour. European Journal of Personality, 17(2), 95117. doi:10.1002/per.467
Prinzie, P., Onghena, P., & Hellinckx, W. (2007). Reexamining the parenting scale. European Journal of Psychological Assessment, 23(1), 2431. doi:10.1027/1015-5759.23.1.24
Prinzie, P., Stams, G. J., Dekovic, M., Reijntjes, A. H., & Belsky, J. (2009). The relations between parents’ big five personality factors and parenting: A meta-analytic review. Journal of Personality and Social Psychology, 97(2), 351362. doi:10.1037/a0015823
Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., … Miles, Q. S. (2009). Aggression after traumatic brain injury: Prevalence and correlates. The Journal of Neuropsychiatry and Clinical Neurosciences, 21(4), 420429. doi:10.1176/jnp.2009.21.4.420
Rapee, R., Lyneham, H., Schniering, C., Wuthrish, V., Abbott, M., Hudson, J., & Wignall, A. (2006). Cool kids (School version). Retrieved from
Rashid, M., Goez, H. R., Mabood, N., Damanhoury, S., Yager, J. Y., Joyce, A. S., & Newton, A. S. (2014). The impact of pediatric traumatic brain injury (TBI) on family functioning: A systematic review. Journal of Pediatric Rehabilitation Medicine, 7(3), 241254. doi:10.3233/PRM-140293
Roberts, G., Howard, K., Spittle, A. J., Brown, N. C., Anderson, P. J., & Doyle, L. W. (2008). Rates of early intervention services in very preterm children with developmental disabilities at age 2 years. Journal of Paediatrics and Child Health, 44(5), 276280. doi:10.1111/j.1440-1754.2007.01251.x
Root, A. E., Wimsatt, M., Rubin, K. H., Bigler, E. D., Dennis, M., Gerhardt, C. A., … Yeates, K. O. (2016). Children with traumatic brain injury: Associations between parenting and social adjustment. Journal of Applied Developmental Psychology, 42, 17. doi:10.1016/j.appdev.2015.10.002
Roth, R. M., Isquith, P. K., & Gioia, G. (2005). Behavior rating inventory of executive function: Adult version. Florida: PAR.
Ryan, N. P., van Bijnen, L., Catroppa, C., Beauchamp, M. H., Crossley, L., Hearps, S., & Anderson, V. (2016). Longitudinal outcome and recovery of social problems after pediatric traumatic brain injury (TBI): Contribution of brain insult and family environment. International Journal of Developmental Neuroscience, 49, 2330. doi:10.1016/j.ijdevneu.2015.12.004
Sandi, C., & Richter-Levin, G. (2009). From high anxiety trait to depression: A neurocognitive hypothesis. Trends in Neurosciences, 32(6), 312320. doi:10.1016/j.tins.2009.02.004
Saunders, C. T., & Blume, J. D. (2017). A classical regression framework for mediation analysis: Fitting one model to estimate mediation effects. Biostatistics, 19(4), 514528. doi:10.1093/biostatistics/kxx054
Schreiber, J. B., Stage, F. K., King, J., Amaury, N., & Barlow, E. A. (2006). Reporting structural equation modelling and confirmatory factor analysis results. The Journal of Educational Research, 99(6), 323337.
Schoemaker, K., Bunte, T., Espy, K. A., Dekovic, M., & Matthys, W. (2014). Executive functions in preschool children with ADHD and DBD: An 18-month longitudinal study. Dev Neuropsychol, 39(4), 302315. doi:10.1080/87565641.2014.911875
Schuurmans, A. A. T., Nijhof, K. S., Engels, R., & Granic, I. (2018). Using a videogame intervention to reduce anxiety and externalizing problems among youths in residential care: An initial randomized controlled trial. Journal of Psychopathology and Behavioral Assessment, 40(2), 344354. doi:10.1007/s10862-017-9638-2
Shields, G. S., Moons, W. G., Tewell, C. A., & Yonelinas, A. P. (2016). The effect of negative affect on cognition: Anxiety, not anger, impairs executive function. Emotion, 16(6), 792797. doi:10.1037/emo0000151
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422445. doi:10.1037/1082-989x.7.4.422
Siegler, R., Saffran, J. R., Eisenberg, N., DeLoache, J., Gershoff, E., & Leaper, C. (2017). How children develop (5th ed.). New York: Worth Publishers Macmillan Learning.
Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., … Faraone, S. V. (2010). Emotional lability in children and adolescents with attention- deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry, 51(8), 915923. doi:10.1111/j.1469-7610.2010.02217.x
Spencer-Smith, M., & Anderson, V. (2009). Healthy and abnormal development of the prefrontal cortex. Developmental Neurorehabilitation, 12(5), 279297. doi:10.3109/17518420903090701
Streiner, D. (2005). Finding our way: An introduction to Path Analysis. Research Methods in Psychiatry, 50(2), 115122.
Taylor, H. G., Yeates, K. O., Wade, S. L., Drotar, D., Stancin, T., & Burant, C. (2001). Bidirectional child-family influences on outcomes of traumatic brain injury in children. Journal of the International Neuropsychological Society, 7, 755767.
VanderWeele, T. J., & Vansteelandt, S. (2014). Mediation analysis with multiple mediators. Epidemiologic Methods, 2(1), 95115. doi:10.1515/em-2012-0010
Verkhratsky, A., & Parpura, V. (2014). Neurological and psychiatric disorders as a neuroglial failure. Periodicum Biologorum, 116(2), 115124.
Wade, S. L., Zhang, N., Yeates, K. O., Stancin, T., & Taylor, H. G. (2016). Social environmental moderators of long-term functional outcomes of early childhood brain injury. JAMA Pediatrics, 170(4), 343349. doi:10.1001/jamapediatrics.2015.4485
Wilson, B. A., Winegardber, J., van Heugten, C., & Ownsworth, T. (2017). Neuropsychological Rehabilitation. London and New York: Routledge.
Woods, D., Catroppa, C., Barnett, P., & Anderson, V. (2011). Parental disciplinary practices following acquired brain injury in children. Developmental Neurorehabilitation, 14(5), 274282. doi:10.3109/17518423.2011.586371
Woods, D., Catroppa, C., Godfrey, C., Giallo, R., Matthews, J., & Anderson, V. (2014). A telehealth intervention for families caring for a child with traumatic brain injury (TBI). Social Care and Neurodisability, 5(1), 5162. doi:10.1108/scn-01-2013-0002
Zelazo, P. D., Qu, L., & Kesek, A. C. (2010). Hot executive function: Emotion and the development of cognitive control. In S. D. Calkins & M. A. Bell (Eds.), Child development at the intersection of emotion and cognition. (pp. 97111). Washington, DC: American Psychological Association.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed